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Illinois has lined up just six carriers to sell 165 health insurance policies on its state exchange, sparking worry that insurers nationwide intend to limit their participation in marketplaces, experts say. If the trend continues, higher premiums and less competition could result.

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Missouri officials signed a $147 million contract with EngagePoint, based in Florida, to create an online Medicaid enrollment system. The Affordable Care Act requires that state Medicaid enrollment systems communicate with the health insurance exchange used in the state. Missouri's exchange will be run by the federal government.

The Minnesota Legislature on Monday approved a plan to create a health insurance exchange, in a 39-28 Senate vote. The legislation, approved earlier by the House, now goes to Gov. Mark Dayton, a Democrat, who has said he will sign it and whose administration already has begun work on building the exchange.

A Minnesota bill that would force hospitals to meet nurse staffing standards may be stalled in the state Legislature. A committee leader wants hospitals and nurses to move toward a consensus before a hearing is scheduled.

Officials with the Nebraska Health Information Initiative, Kansas Health Information Network and Missouri Health Connection announced that providers in their states can now exchange Direct secured messages. The move will allow physicians to offer better and more coordinated care to patients in border areas who may cross state lines for health care.